Blepharitis is a bilateral recurrent inflammation of the ciliary edge of the eyelids. Blepharitis is manifested by redness and swelling of the edges of the eyelids, a feeling of heaviness and itching of the eyelids, hypersensitivity to bright light, rapid fatigue of the eyes, improper growth and loss of eyelashes. In the diagnosis, the leading role is played by external examination of the eyelids, determination of visual acuity, biomicroscopy, bacteriological seeding, examination of eyelashes for demodex. Treatment is aimed at eliminating the cause of the disease and, as a rule, includes conservative measures (eyelid toilet, eyelid massage, instillation of eye drops, laying ointments, etc.).
The prevalence of blepharitis in the population is quite high – about 30%. Disease can develop in children, but the maximum peak incidence occurs at the age of 40 to 70 years. In ophthalmology, blepharitis is a large group of etiologically heterogeneous inflammatory diseases of the eyelids, accompanied by damage to their ciliary edges, having a recurrent course and difficult to treat. Severe and persistent blepharitis can lead to the formation of chalazion, conjunctivitis, keratitis, and impaired vision.
Causes of belepharitis
The development can be caused by a lot of reasons. Infectious blepharitis is caused by bacteria (epidermal and Staphylococcus aureus), fungi, mites; non–infectious – allergic agents, ophthalmic diseases.
The leading cause is staphylococcal infection affecting the hair sacs of eyelashes. The occurrence of blepharitis is predisposed by the presence of chronic foci of infection in the tonsils (tonsillitis), paranasal sinuses (sinusitis, frontitis), oral cavity (caries), on the skin (impetigo), etc. Often blepharitis is caused by the defeat of the edges of the eyelids by the Demodex tick (Demodex). In most people, ticks live on the surface of the skin, in hair follicles, sebaceous glands, and with a decrease in the overall reactivity of the body, they can become active and get on the skin of the eyelids, causing blepharitis. Less often, etiological agents in blepharitis are herpes viruses of types I, II and III, contagious mollusc, hemophilic bacillus, intestinal bacteria, yeast-like fungi, etc. When disease is combined with conjunctivitis, blepharoconjunctivitis develops.
The development of non-infectious blepharitis is often associated with uncorrected visual pathology (hyperopia, myopia, astigmatism), dry eye syndrome. People with hypersensitivity to irritants (plant pollen, cosmetics, hygiene products, medicines) may develop an allergic form. The lesion of the eyelids often occurs with contact dermatitis. Endogenous allergization of the body is possible with helminthiasis, gastritis, colitis, cholecystitis, tuberculosis, diabetes mellitus, in which the composition of the secretion of the meibomian glands changes.
A decrease in the immune status, chronic intoxication, hypovitaminosis, anemia, increased smoke and dustiness and air, staying in a solarium, in the sun, in the wind predisposes to the occurrence and exacerbation of any etiology.
According to the etiology, blepharitis is divided into two groups: non-infectious and infectious. When only the ciliary edge of the eyelid is involved in the inflammatory process, it is said about anterior marginal blepharitis; when the meibomian glands are affected, about posterior marginal blepharitis; in case of predominance of inflammatory phenomena in the corners of the eyes, about angular or angular blepharitis.
According to the clinical course , several forms are distinguished:
- Seborrheic or scaly (usually accompanied by seborrheic dermatitis).
- Ulcerative or staphylococcal (ostiofolliculitis).
- Acne or rosacea-blepharitis (often combined with pink acne).
Symptoms of blepharitis
The course of any form is accompanied by typical manifestations: swelling and redness of the eyelids, itching, rapid fatigue of the eyes and hypersensitivity to stimuli (light, wind). The constantly forming tear film causes blurred vision. Ocular discharge, especially accompanying the course of infectious blepharitis, leads to the appearance of plaque on the eyelid, gluing of eyelashes. Patients who usually use contact lenses note that they cannot wear them for as long as before.
Simple blepharitis is characterized by hyperemia and thickening of the edges of the eyelids, accumulation of whitish-gray secretions in the corners of the eye slits, moderate redness of the conjunctiva, expansion of the ducts of the meibomian glands.
With scaly blepharitis, flakes of the exfoliated epidermis and epithelium of the sebaceous glands accumulate on the thickened and hyperemic edge of the eyelid, which are tightly attached to the base of the eyelashes. Skin scales are also detected on the eyebrows and scalp. The course of seborrheic blepharitis may be accompanied by loss and graying of eyelashes.
The ulcerative form proceeds with the formation of yellowish crusts, when removed, ulcers open. After the ulceration heals, scars form, which disrupt the normal growth of eyelashes (trichiasis). In severe cases, the eyelashes may discolor (polyosis) and fall out (madarosis), and the anterior ciliary edge becomes hypertrophied and wrinkled.
Demodectic blepharitis occurs with constant unbearable itching of the eyelids, more pronounced after sleep. The edges of the eyelids thicken in the form of a reddish roller. In the daytime, there is a pain in the eyes, the release of a sticky secret, leading to drying of the discharge and its accumulation between the eyelashes, which gives the eyes an untidy appearance.
Symptoms of allergic blepharitis, in most cases, appear suddenly and are clearly associated with some exogenous factor. The disease is accompanied by swelling and persistent itching of the eyelids, lacrimation, mucous discharge from the eyes, photophobia, pain in the eyes. For allergic blepharitis, darkening of the eyelid skin is typical (the so-called “allergic bruise”).
With rosacea blepharitis, small grayish-red nodules crowned with pustules are visible on the skin of the eyelids.
Disease can occur with the phenomena of conjunctivitis, dry eye syndrome, keratitis, acute meibomitis, the development of chalazion, the formation of barley, flicken and corneal ulcers threatening vision loss. Disease almost always takes a chronic course, tends to recur for many years.
Disease is recognized by an ophthalmologist based on complaints, eyelid examination data, detection of concomitant diseases, laboratory tests. During the diagnosis of blepharitis, visual acuity is determined and biomicroscopy of the eye is performed, which allows assessing the condition of the edges of the eyelids, conjunctiva, eyeball, tear film, cornea, etc. In order to identify previously unrecognized hypermetropia, myopia, presbyopia, astigmatism, the state of refraction and accommodation is investigated.
To confirm demodectic blepharitis, a microscopic examination of the eyelashes for the Demodex tick is performed. If infectious blepharitis is suspected, bacteriological sowing of a smear from the conjunctiva is indicated. With the allergic nature of blepharitis, it is necessary to consult an allergist-immunologist with an allergy test. In order to exclude worm infestation, it is advisable to prescribe a stool analysis for worm eggs.
Long-term blepharitis, accompanied by hypertrophy of the edges of the eyelids, requires the exclusion of sebaceous gland cancer, squamous or basal cell carcinoma, for which a biopsy with histological examination of the tissue is performed.
Treatment of blepharitis
Blepharitis treatment is conservative, long-term, requiring a comprehensive local and systemic approach, as well as consideration of etiological factors. Often, to eliminate blepharitis, consultations of narrow specialists (otolaryngologist, dentist, dermatologist, allergist, gastroenterologist) are required, rehabilitation of chronic foci of infection and deworming, normalization of nutrition, improvement of sanitary and hygienic conditions at home and at work, increased immunity. When detecting refractive errors, it is necessary to carry out their eyeglass or laser correction.
Topical therapy requires taking into account the form of the disease. In the treatment of blepharitis of any etiology, a thorough hyena of the eyelids is necessary, cleansing of crusts and scales with a wet swab after preliminary application of penicillin or sulfacyl ointment, instillation of sulfacetamide into the conjunctival cavity, treatment of the edges of the eyelids with diamond green, eyelid massage.
For ulcerative blepharitis, ointments containing corticosteroid hormone and an antibiotic (dexamethasone + gentamicin, dexamethasone + neomycin + polymyxin B) are used. For conjunctivitis and marginal keratitis, treatment is supplemented with similar eye drops. In cases of corneal ulceration, an eye gel with dexpantheol is used.
With seborrheic blepharitis, lubrication of the eyelids with hydrocortisone eye ointment, instillation of an “artificial tear” is indicated. In the treatment of demodectic blepharitis, in addition to general hygienic measures, special antiparasitic ointments (metronidazole, zinc-ichthyol), alkaline drops are used; systemic therapy with metronidazole is carried out.
Allergic form disease requires the elimination of contact with the identified allergen, instillation of antiallergic drops (lodoxamide, sodium cromoglycate), treatment of the eyelids with corticosteroid eye ointments, taking antihistamines. With meibomian and acne blepharitis, it is advisable to prescribe tetracycline or doxycycline inside a course of 2 to 4 weeks.
Systemic therapy for blepharitis includes vitamin therapy, immunostimulating therapy, and autohemotherapy. Effective combination of local and general drug treatment with physiotherapy (UHF, magnetotherapy, electrophoresis, darsonvalization, UFO), irradiation with Bucca rays.
With complicated forms of blepharitis, surgical treatment may be required: removal of chalazion, eyelid surgery for trichiasis, correction of inversion or inversion of the eyelid.
Prevention and prognosis
With timely and persistent therapy, the prognosis for the preservation of vision is favorable. In some cases, the disease acquires a prolonged, recurrent course, leading to the appearance of barley, chalazions, deformation of the edges of the eyelids, the development of trichiasis, chronic blepharoconjunctivitis and keratitis, deterioration of vision function.
For prevention, it is necessary to treat chronic infections, exclude contact with allergens, correct refractive errors, timely treatment of sebaceous gland dysfunction, observe visual hygiene, improve sanitary and hygienic working and living conditions.